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Bortezomib and Vorinostat in Treating Patients With High-Risk Myelodysplastic Syndrome or Acute Myeloid Leukemia
This study is currently recruiting participants.
Verified by National Cancer Institute (NCI), January 2009
Sponsors and Collaborators: Masonic Cancer Center, University of Minnesota
National Cancer Institute (NCI)
Information provided by: National Cancer Institute (NCI)
ClinicalTrials.gov Identifier: NCT00818649
  Purpose

RATIONALE: Bortezomib and vorinostat may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth. Giving bortezomib together with vorinostat may kill more cancer cells.

PURPOSE: This phase II trial is studying how well giving bortezomib together with vorinostat works in treating patients with high-risk myelodysplastic syndrome or acute myelogenous leukemia.


Condition Intervention Phase
Leukemia
Myelodysplastic Syndromes
Drug: bortezomib
Drug: vorinostat
Procedure: laboratory biomarker analysis
Phase II

MedlinePlus related topics: Cancer Leukemia, Adult Acute Leukemia, Adult Chronic
Drug Information available for: Suberoylanilide hydroxamic acid Bortezomib
U.S. FDA Resources
Study Type: Interventional
Study Design: Treatment, Open Label
Official Title: Phase II Trial of Velcade Plus Vorinostat in the Treatment of High Risk MDS and Relapsed/Refractory AML

Further study details as provided by National Cancer Institute (NCI):

Primary Outcome Measures:
  • Clinical response at the completion of 3 courses of therapy as assessed by the International Working Group response criteria [ Designated as safety issue: No ]
  • Toxicity as assessed by NCI CTCAE v3.0 [ Designated as safety issue: Yes ]

Secondary Outcome Measures:
  • Analysis of natural killer (NK) cell activating and inhibitory receptor alterations, NK cell receptor ligand alterations, HLA class I expression on target cells (myeloid blasts), and NK-mediated cell killing [ Designated as safety issue: No ]
  • Correlation of the above changes with response [ Designated as safety issue: No ]

Estimated Enrollment: 46
Study Start Date: January 2009
Estimated Primary Completion Date: June 2011 (Final data collection date for primary outcome measure)
Detailed Description:

OBJECTIVES:

Primary

  • To determine the clinical response to bortezomib and vorinostat in patients with high-risk myelodysplastic syndromes or acute myeloid leukemia, as defined by the International Working Group response criteria.

Secondary

  • To characterize the quantitative and qualitative toxicities of this regimen in these patients.
  • To assess the effect of this regimen on natural killer (NK) cell function, in terms of activating and inhibitory receptor alterations, target cell ligand and HLA class I modulation, and NK-mediated cell killing.
  • To correlate the above changes with clinical response.

OUTLINE: Patients receive bortezomib IV on days 1, 4, 8, and 11 and oral vorinostat once daily on days 1-14. Treatment repeats every 21 days for 3 courses in the absence of disease progression or unacceptable toxicity. Patients who achieve a complete response, partial response, or hematologic improvement may receive 3 additional courses of therapy (for a maximum of 6 courses).

Bone marrow and peripheral blood samples are collected at baseline, on day 15 of course 1, and at the completion of 3 courses of therapy for analysis of target cells (myeloid blasts) (i.e., HLA class I receptor analysis and natural killer [NK] cell receptor ligand analysis) and analysis of activating NK cell receptor alterations and NK-mediated cell killing.

After completion of study treatment, patients are followed periodically for up to 1 year.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

DISEASE CHARACTERISTICS:

  • Pathologically confirmed diagnosis of one of the following:

    • Myelodysplastic syndromes meeting any of the following criteria:

      • Intermediate-2 or high-risk disease, defined by the International Prognostic Scoring System
      • Refractory anemia with excess blasts (RAEB)-1 or RAEB-2, defined by the WHO Classification
      • High-risk cytogenetic abnormality, defined by the presence of monosomy 7 or complex karyotype
      • Disease progression during prior standard therapy with either azacitidine or decitabine
      • History of 5q minus syndrome that progressed during prior treatment with lenalidomide
    • Acute myeloid leukemia, including histologic subtypes M0, M1, M2, M4, M5, M6, or M7, and meets 1 of the following criteria:

      • Refractory disease or induction failure, defined as failure to achieve initial remission after 2 lines of induction therapy
      • Relapsed disease, defined as second relapse or higher
      • Newly diagnosed or untreated disease

        • Unable to tolerate potentially curative conventional induction chemotherapy due to advanced age, end organ limitations, or performance status limitations OR refused conventional induction therapy
  • Must have stable bone marrow function for > 7 days prior to study entry

    • Patients with WBC > 10,000/mm³ or peripheral blast count > 5,000/mm³ are eligible provided WBC and blast counts are controlled (i.e., WBC ≤ 10,000/mm³ and peripheral blast count ≤ 5,000/mm³) with hydroxyurea prior to study entry
  • No active CNS disease

    • Patients with clinical symptoms of active CNS disease must have negative cytology by lumbar puncture

PATIENT CHARACTERISTICS:

  • Karnofsky performance status 60-100%
  • Hemoglobin > 8 g/dL (packed RBC transfusion allowed)
  • Platelet count > 20,000/mm³ (platelet transfusion allowed)
  • Creatinine ≤ 2.0 mg/dL OR creatinine clearance ≥ 40 mL/min
  • ALT/AST ≤ 3 times upper limit of normal
  • Total bilirubin ≤ 2.0 mg/dL
  • Not pregnant or nursing
  • Negative pregnancy test
  • Fertile patients must use effective contraception
  • LVEF ≥ 40% (testing required if symptomatic or there is a known prior impairment)
  • No QT prolongation with QT interval > 0.5 seconds
  • No clinical evidence of heart failure
  • No history of uncontrolled hypertension
  • No myocardial infarction within the past 6 months
  • No NYHA class III or IV heart failure
  • No uncontrolled angina
  • No severe uncontrolled ventricular arrhythmia
  • No acute ischemia or active conduction system abnormalities by ECG
  • No peripheral neuropathy ≥ grade 2 within the past 14 days
  • No untreated positive blood cultures or progressive infections as assessed by radiographic studies
  • No known hypersensitivity to bortezomib, boron, or any other agents used in this study
  • No history of deep vein thrombosis or pulmonary embolism that has not been adequately treated with systemic anticoagulation or that was diagnosed within the past 2 months
  • No serious medical or psychiatric illness that would preclude study participation
  • No active HIV or viral hepatitis infection
  • No other concurrent malignancy except localized basal cell or squamous cell skin cancer

PRIOR CONCURRENT THERAPY:

  • See Disease Characteristics
  • Recovered from all prior therapy (≤ grade 1 toxicity as defined by NCI CTCAE v3.0 criteria)
  • More than 2 weeks since prior treatment for myeloid disorder, including chemotherapy, hematopoietic growth factors, or biological therapy (e.g., monoclonal antibodies)

    • Hydroxyurea to control WBC counts allowed provided last dose was given ≥ 48 hours prior to study entry
  • At least 30 days since prior valproic acid for seizures
  • No other prior histone deacetylase inhibitors
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00818649

Locations
United States, Minnesota
Masonic Cancer Center at University of Minnesota Recruiting
Minneapolis, Minnesota, United States, 55455
Contact: Clinical Trials Office - Masonic Cancer Center at University o     612-624-2620        
Sponsors and Collaborators
Masonic Cancer Center, University of Minnesota
Investigators
Principal Investigator: Erica Warlick, MD Masonic Cancer Center, University of Minnesota
  More Information

Clinical trial summary from the National Cancer Institute's PDQ® database  This link exits the ClinicalTrials.gov site

Responsible Party: Masonic Cancer Center at University of Minnesota ( Erica Warlick )
Study ID Numbers: CDR0000630472, UMN-2008LS044, 2008-06R, 0808M44081, MILLENNIUM-X05269
Study First Received: January 7, 2009
Last Updated: January 7, 2009
ClinicalTrials.gov Identifier: NCT00818649  
Health Authority: Unspecified

Keywords provided by National Cancer Institute (NCI):
de novo myelodysplastic syndromes
previously treated myelodysplastic syndromes
secondary myelodysplastic syndromes
refractory anemia with excess blasts
adult acute myeloblastic leukemia with maturation (M2)
adult acute myeloblastic leukemia without maturation (M1)
adult acute minimally differentiated myeloid leukemia (M0)
adult acute myelomonocytic leukemia (M4)
adult acute monoblastic leukemia (M5a)
adult acute monocytic leukemia (M5b)
adult erythroleukemia (M6a)
adult pure erythroid leukemia (M6b)
adult acute megakaryoblastic leukemia (M7)
recurrent adult acute myeloid leukemia
untreated adult acute myeloid leukemia
adult acute myeloid leukemia with 11q23 (MLL) abnormalities
adult acute myeloid leukemia with inv(16)(p13;q22)
adult acute myeloid leukemia with t(16;16)(p13;q22)
adult acute myeloid leukemia with t(8;21)(q22;q22)

Study placed in the following topic categories:
Leukemia, Monocytic, Acute
Precancerous Conditions
Refractory anemia
Acute myelomonocytic leukemia
Leukemia, Myeloid, Acute
Di Guglielmo's syndrome
Leukemia
Preleukemia
Anemia, Refractory
Neoplasm Metastasis
Acute erythroblastic leukemia
Acute myeloid leukemia, adult
Congenital Abnormalities
Acute myelocytic leukemia
Myelodysplastic syndromes
Hematologic Diseases
Bortezomib
Vorinostat
Myelodysplastic Syndromes
Myelodysplasia
Anemia
Acute myelogenous leukemia
Leukemia, Myeloid
Recurrence
Leukemia, Myelomonocytic, Acute
Leukemia, Erythroblastic, Acute
Anemia, Refractory, with Excess of Blasts
Bone Marrow Diseases
Acute monoblastic leukemia

Additional relevant MeSH terms:
Anticarcinogenic Agents
Anti-Inflammatory Agents
Neoplasms by Histologic Type
Disease
Molecular Mechanisms of Pharmacological Action
Antineoplastic Agents
Physiological Effects of Drugs
Enzyme Inhibitors
Protective Agents
Pharmacologic Actions
Protease Inhibitors
Neoplasms
Pathologic Processes
Analgesics, Non-Narcotic
Sensory System Agents
Therapeutic Uses
Syndrome
Anti-Inflammatory Agents, Non-Steroidal
Analgesics
Peripheral Nervous System Agents
Antirheumatic Agents
Central Nervous System Agents

ClinicalTrials.gov processed this record on January 16, 2009